Our objective for this R34 is to systematically modify the existing evidence-based intervention, """"""""Seeking Safety"""""""" (SS), by integrating a gender-specific HIV intervention (Project FIO) and critical cultural components for Asian-Pacific Islander (API) women who report a history of violent traumatic experience or a diagnosis of Post-Traumatic Stress Disorder (PTSD). This proposal is significant because it aims to reduce two public health problems among API women: 1) the rapidly rising incidence of HIV/STIs, and 2) the highest rates of completed suicide between the ages 15 to 24 among all racial groups of women. A preliminary study based on a K01 identified a strong association between lifetime sexual and physical trauma and health risk behaviors in API women. Specifically, those who experienced trauma had elevated risks of suicidality, substance use, and HIV risk behaviors. To date, no specific intervention that integrates sexual and mental health promotion has been tested for the APIs population, despite it is the fastest growing in the US. The most commonly applied, empirically-supported intervention for women who have experienced trauma is SS.1 However, the intervention should be culturally appropriate and grounded in """"""""the real world"""""""" of API women affected by trauma. Thus, we will develop new protocols, which incorporate SS, Project FIO (Future is Ours), API women's unique experiences and voices, and feedback from intervention experts and an API Community Advisory Board (CAB) (Aim 1). We propose to test the feasibility and safety of a pilot randomized clinical trial (RCT) using a two- armed design (with an intervention group of 36, and a wait-list control group of 36) (Aim 2). We will launch AWARE (Asian Women's Action for Resilience and Empowerment) to screen at least 400 women in the greater Boston area and recruit a total of 72 women who meet the criteria for PTSD and traumatic history. The 10-week intervention will be given group psychotherapy along with secure daily mobile text messages (""""""""AWARE Stories""""""""). Adherence to group psychotherapy, utilization/satisfaction of secure mobile messages, and safety (suicidality and intimate partner violence) will be tested as feasibility outcomes. We also aim to test the efficacy of AWARE (Aim 3). We will measure HIV-related outcomes (primary outcomes) and psychiatric symptoms and substance use (secondary outcomes) at baseline, week 10, and 3 months to determine effect sizes for outcomes of the adapted intervention. This integrative, holistic approach is innovative in multiple ways: (1) the study will be the first pilot RCT study to target traumatized API women, (2) it incorporates a culturally appropriate intervention to be widely available, acceptable, and feasible, (3) it is designed to reduce HIV risk behavior, and (4) it tests the feasibility of a moble technology. The proposed research project responds to multiple priorities of NIH, NIMH, and Healthy People 2010. In the future, the findings can be translated into a larger RCT. It is our aim that these efforts will ultimately lead to the reduction of HIV transmission, suicidality, and psychiatric symptoms among API women.

Public Health Relevance

This project responds to two critical public health problems among API women: HIV risk behaviors and poor mental health functioning. The purpose of this R34 is to design and test the feasibility of an intervention that systematically modifies Seeking Safety (SS) by integrating gender specific HIV/STD risk reduction intervention (Project FIO) and cultural components specific to API women's real world. This project addresses objective 3 and 4 of the NIMH (2008) strategic plan, which entail developing improved interventions that incorporate diverse individuals with mental illnesses and enhancing the public health impact of NIMH-supported research.